Obamacare Might Have Prevented the Stabbing of Creigh Deeds

New details are coming out about the stabbing of Virginia State Senator Creigh Deeds by his son, Austin Deeds, who then shot himself to death. My first reaction was, like most people I imagine, thoughts of some dark family history. But according to new reports, Austin was suffering from some kind of severe mental illness. The day before, they had tried to have him committed, but there were no beds to be found:

The younger Deeds was evaluated under an emergency custody order by mental health professionals on Monday and released, Dennis Cropper, executive director of the Rockbridge County Community Services Board, told the Richmond Times-Dispatch on Tuesday.

Cropper said the emergency custody order allowed Deeds to be held as long as four hours to determine whether he should be kept longer under a temporary detention order, which could last up to 48 hours.

The son was evaluated Monday at Bath Community Hospital, Cropper said, but was released because no psychiatric bed could be located across a wide area of Western Virginia.

Between 2009 and 2011, states experienced a cumulative shortfall of $432 billion. Mental health agencies in almost every state have cut expenditures, even as recession increases demand for community mental health services, crisis services, and emergency department services.

So what will Obamacare do to change things? Here’s Harold:

Why do so many people at risk—many of them young low-income men—fail to receive appropriate mental health services? The most important single reason is this: most are categorically ineligible for Medicaid. These men are not custodial parents. They are not veterans. They have not (yet) been diagnosed with federally recognized disabilities. Many get into trouble because they have serious drug or alcohol disorders. Since 1996, substance use disorders are no longer qualifying conditions for federal disability programs…

In theory, both within Medicaid and outside it, the ACA expands the range of mental health and substance abuse services. Insurance plans within the new state insurance exchanges must cover mental health and substance abuse services—and do so under conditions of “parity” so that copayments and other details match plans’ coverage of physical health conditions. In the fine print, evidence-based approaches including screening, brief intervention, and referral to treatment for alcohol disorders are supported in emergency departments and other medical settings.

Now, Austin was almost certainly not eligible for Medicaid. (And as Harold says, it’s important to note that the vast majority of mentally ill people are not violent.) But by hugely expanding Medicaid, and requiring that all insurance cover mental health and substance abuse, Obamacare will make a great deal more money available for mental health services, and capacity will expand to take advantage of the opportunity. Unfortunately, these full reforms don’t take effect until 2014, and it will take more time to build capacity back up.

But with a bit of luck, future attempts to help young men stricken with severe mental illness will not be stymied for such a wretched reason as not enough beds.